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Evaluation of IP Video Technologies for Telemedicine: The East Carolina University Experience Scott C. Simmons Director, Design & Development ECU Telemedicine.

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Presentation on theme: "Evaluation of IP Video Technologies for Telemedicine: The East Carolina University Experience Scott C. Simmons Director, Design & Development ECU Telemedicine."— Presentation transcript:

1 Evaluation of IP Video Technologies for Telemedicine: The East Carolina University Experience Scott C. Simmons Director, Design & Development ECU Telemedicine Center

2 Overview ECU Telemedicine Center Overview Internet Telemedicine NIH/NLM Biomedical Applications of the NGI Testing CODEC/Network Performance Lessons Learned Future Directions

3 ECU Telemedicine Center Links patients to physicians, MD-to-MD, hospital to hospital Over 8,000 consults since 1991 Hospitals, clinics, homes 14,000 square mile service area 32 clinical specialties Distance Learning and Grand Rounds Virtual Surgery (DaVinci)

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5 Internet Telemedicine IP videoconferencing (H.323, MPEG) Use of PCs and Internet for asynchronous consults, i.e. store-and-forward Other capabilities –telemetry of data –electronic mail with attachments –file transfer –whiteboarding –application sharing –chat

6 IP Collaboration Technologies Can use existing IP infrastructure? Different technologies –H.323 –MPEG-1, 2, (4) –Access Grid

7 Biomedical Applications of the Next Generation Internet (NGI) NLM (NIH) initiative for innovative medical projects that demonstrate the application and use of NGI capabilities: –Quality of service –Medical data privacy and security –Nomadic computing –Network management –Infrastructure technology for scientific collaboration

8 ECU TM Center NLM Contract ECU Telemedicine Center awarded 3-year, $4.6 M contract for Internet Protocol Telemedicine and Pediatric Cardiology Education (N01-LM ) –IP telemedicine (10 specialties) –Store-and-forward cineangiograms –Electromyography –Pediatric cardiology education –Microwebservers

9 Testing CODEC & N/W Performance First test in lab, then in Eastern NC network SMPTE time code – dropped video frames Video test equipment – objective video quality Clinical opinion of diagnostic quality using gold standard sources

10 Advertised vs. Actual FPS 768 (H.320) = (H.323) = 14 fps

11 Advertised vs. Actual FPS (contd) 400 (H.323) = 15 fps 768 (H.323) = 26 fps

12 Video Testing SMPTE Color Bars – WaveformSMPTE Color Bars – Vectorscope Luminance 5 StepMultiburst 100

13 Video Testing Setup

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15 Audio Testing – White Noise Polycom MinervaVbrick

16 Audio Testing – Stethoscope Polycom MinervaVbrick

17 Physician Assessment of Dx Quality Gold standard DV tapes developed in 10 specialties: Adult Cardiology, Allergy, Dermatology, Endocrinology, Obstetrics, Pediatric cardiology, Psychiatry, Pulmonology, Rehabilitation Medicine, Trauma Tapes played through codecs with different network (bandwidth) settings Three physicians/specialty assessed point at which video/audio was unusable for Dx Results used to select codecs for regional network

18 Physician Assessment Test N/W

19 Findings from Physician Assessment Polycom best H.323 Vbrick best MPEG 7 video packet/minute loss threshold for diagnosis H.323 manages lost audio by repeating – this can sound like cardiac anomaly Similarly, crackles (lung sound) can be lost MPEG best for clinical audio (heart & lung sounds)

20 IP networks not designed/optimized for videoconferencing Technical issues: –Congestion/packet loss –Variable bit rate –Security –Directory services –IP multicast Latency is 250+ ms w/o network with current videoconferencing products IP Telemedicine Challenges

21 Overprovision your network Implement quality of service mechanism –Works within your network/campus Reduce inherent latency associated with digitization/encoding Avoid/eliminate bottlenecks –Hubs –Routers (use non-blocking wire-speed switches instead) –Firewalls – How to Address IP Challenges

22 Conduct regional assessment in 45 Mbps wireless network Study reverse of initial lab study to look for correlation (i.e. worst-to-best) Evaluate line-speed encryption technologies Examine new software-only videoconferencing system from TeraMedia & Tulane University Bioinformatics Pilot testing of H.323 to homes connected by cable and xDSL service Future Directions

23 Regional Wireless Network Overview ECU Telemedicine Center Bertie Memorial Hospital Roanoke/Chowan Hospital 12.6 mi mi mi mi. 1.9 mi. 1.1 mi. (Diagram not to scale) All radio links 45 Mbps full duplex

24 Future IP Telemedicine Network

25 Contact Information Scott C. Simmons Director, Design & Development ECU Telemedicine Center 600 Moye Blvd., 1S-10 Greenville, NC (252)


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